Student Participation Application

Submit the form online below - or download a form to the right. (Deadline: June 4th, 2017)

Name *

Name

First Name

Last Name

Age *

Gender *

I allow my picture to be used in HWHW publications *

T-shirt size *

Desired Participation *

Please select all that apply

Runner

Kitchen Worker

Painting

Landscaping

Roofing

Construction

Tech

Other

If you wish to participate in some other way, please explain

Church/Group

Pastor/Leader

Home Phone

Home Phone

(###)

###

####

Cell Phone

Cell Phone

(###)

###

####

Date of Birth

Date of Birth

MM

DD

YYYY

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email *

Emergency Contact *

Relationship to Participant

Emergency Contact Phone Day

Emergency Contact Phone Day

(###)

###

####

Emergency Contact Phone Evening

Emergency Contact Phone Evening

(###)

###

####

Doctors Name

Doctors Phone

Doctors Phone

(###)

###

####

Release of Liability *

I hereby release His Work, His Way Bedford, its staff and members of the board of directors, from any liability for injury that I may sustain during His Work, His Way activities. In case of illness of injury, and in the event I am unable to respond, I authorize staff to allow emergency medical treatment or surgery by a licensed physician or hospital.

Thank you!

Cost & Info

Cost: $60 per person includes food, work, a really cool His Work His Way Bedford t-shirt and quite possibly the best week of your life!

COMPLETELY fill out the inside of this brochure and return it to:

Crossroads Bible Church

5564 Business Route 220, Bedford PA 15522

OR Submit your online application on the left.

By Sunday, June 4, 2017 with your $60.

CHECKS CAN BE MADE PAYABLE TO CROSSROADS BIBLE CHURCH with a memo note HWHW.

Once His Work, His Way Bedford receives your completed registration form and your $60, you will receive information through your local church the first of June. Please read over ALL of this information.

What is His Work His Way Bedford?

His Work, His Way is a nonprofit Christian, community development organization located in Bedford, Pennsylvania. Our purpose includes upholding the dignity of vulnerable homeowners who live in Bedford and neighboring communities. This summer, we will be sending out crews of teenage and adult volunteers who will give freely of their time and energy to perform free home repairs for homeowners. Our hope is to touch lives with the love of Christ by using paint brushes, hammers, shingles, rakes and drywall.

Expect to grow and connect through worship, speakers, small groups, evening activities and more!

Who Can Participate?

Anyone entering 7th grade the next school year and above can participate. This is to ensure that students have the opportunity to grow spiritually through the evening activities with the youth leaders and fellow participants. In addition, to ensure the safety of all students, parental contact needs to take place over the phone.